=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508055609
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY C WAY M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2007
-----------------------------------------------------
Last Update Date | 10/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6211 BISHOP BOULEVARD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-768-2277
-----------------------------------------------------
Fax | 214-768-2911
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 750195 6211 BISHOP BLVD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75275-0195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-768-2277
-----------------------------------------------------
Fax | 214-768-2911
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | H6693
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------